Elective stenting of carotid artery stenosis in patients with severe coronary artery disease

Abstract

Aims To evaluate the feasibility and safety of elective carotid stent implantation in patients with carotid stenoses and concomitant coronary artery disease, as an alternative to combined carotid and coronary surgery. MethodsWe treated 50 patients with >70% stenoses in 53 carotid arteries with balloon angioplasty followed by elective stent implantation. All patients had severe coronary artery disease, and/or mitral insufficiency, aortic stenosis, rhythm disorders or generalized arteriosclerosis. In three patients the opposite carotid artery was occluded; nine patients had bilateral stenoses of which two received stents bilaterally.Results Fifty-six successful stent implantations (42 Wallstents, eight BeStents, two AVE-Microstents, one Palmaz Schatz stent, three Sito stents) were performed, reducing the baseline percent stenosis from 78 18% to 13 11%. Complications included three transient ischaemic attacks, one minor and one major stroke. Follow-up was available for 46 patients over a mean of 10 months. Three asymptomatic restenoses and one deformation of a BeStent occurred. ConclusionOur preliminary results indicate that carotid artery stenting in patients with concomitant severe coronary artery disease is feasible, safe, and may be an alternative to combined carotid and coronary surgery.

Reporting Standards for Carotid Artery Angioplasty and Stent Placement

“…This excludes the other studies that represented very-high-risk cohorts. 98,99,[102][103][104][105] Similar favorable results were reported by Al-Mubarak et al, who reported on 51 consecutive patients undergoing simultaneous or staged carotid artery stenting and percutaneous coronary intervention. Technical success was achieved in all carotid arteries, with a minor stroke rate of 4% and no major strokes, myocardial infarctions, or deaths.…”

“…23 NASCET criteria were applied to the patient cohorts in 5 of these carotid stenting series, demonstrating that 79% of these 574 patients would have failed eligibility because of comorbidities. 91,95,96,99 Despite this, morbidity rates of 2.0% to 7.9% and mortality rates of 0.6% to 2.0% for these early carotid stenting reports compare favorably to those in the NASCET and the ECST. However, 41% (nϭ233) of these patients had asymptomatic carotid stenosis for which lower endarterectomy morbidity and mortality rates would be expected.…”

“…Since 1996, there have been 11 large carotid stent series published in which the total number of patients is 1311 71,[91][92][93][94][95][96][97][98][99][100][101] (Table 3). Comparative analysis of these reports is made difficult by inconsistencies in the sample populations, lesion characteristics, endovascular techniques, and outcome data.…”

A Systematic Review of Outcomes in Patients With Staged Carotid Artery Stenting and Coronary Artery Bypass Graft Surgery

“…Four studies were excluded from the analysis: one because it implied a synchronous approach 17 and the other 3 because they represented consecutive reports from the same institution with small and overlapping patient populations. 9,12,13 Either the latest publication or the publication with the largest number of patients was considered in the analysis. Among studies in which both CEA and CAS were used for carotid revascularization, only those patients undergoing CAS followed by CABG were included.…”

Screening Carotid Arteriography: Why It Still Makes Sense

“…Two arterial spasms (3.3%) and no in-hospital complications were observed. 15 Moreover, the rise in combined interventions, such as endovascular therapy of coronary and carotid disease, 16 carotid angioplasty with heart valve surgery, 17 or even percutaneous cardiac valve implantation in the future, 18 enhances the role of selective carotid angiography in assessing carotid atherosclerosis in candidates for cardiac or peripheral interventions.…”